Kidney Matters - Issue 16 Spring 2022
Kidney Matters is our free quarterly magazine for everyone affected by kidney disease.
This issue includes features on delayed graft function, the impact of CKD on families, friends and care-partners, improving organ donation, a husband's perspective on the challenges faced from caring for someone with CKD, and an article all about a family's journey from dialysis to transplant and all the things in between.
As well as this, the Kidney Kitchen features a warming pear and blackberry crumble, perfect for Valentine's Day!
We know that being a kidney patient can be tough at times and that accessing the right help at the right time isn’t always easy. We’ve spent a great deal of time talking and listening to kidney patients about what we can do to address this at every stage of kidney disease. The response was overwhelmingly ‘improved communication’ on what is going on in the kidney world, how other patients manage their life with kidney disease and what is available to them in terms of support and how to access it.
Kidney Matters has been developed to tackle this as well as the many other issues kidney patients face in day-to-day life. Along with shared patient experiences, Kidney Matters provides information on how to access emotional and practical support, financial assistance through our grant schemes, advice from leading kidney specialists and tips on how to keep as well as possible by eating a healthy diet whilst on dialysis.
Kidney Matters is our free quarterly magazine for everyone affected by kidney disease.
This issue includes features on delayed graft function, the impact of CKD on families, friends and care-partners, improving organ donation, a husband's perspective on the challenges faced from caring for someone with CKD, and an article all about a family's journey from dialysis to transplant and all the things in between.
As well as this, the Kidney Kitchen features a warming pear and blackberry crumble, perfect for Valentine's Day!
We know that being a kidney patient can be tough at times and that accessing the right help at the right time isn’t always easy. We’ve spent a great deal of time talking and listening to kidney patients about what we can do to address this at every stage of kidney disease. The response was overwhelmingly ‘improved communication’ on what is going on in the kidney world, how other patients manage their life with kidney disease and what is available to them in terms of support and how to access it.
Kidney Matters has been developed to tackle this as well as the many other issues kidney patients face in day-to-day life. Along with shared patient experiences, Kidney Matters provides information on how to access emotional and practical support, financial assistance through our grant schemes, advice from leading kidney specialists and tips on how to keep as well as possible by eating a healthy diet whilst on dialysis.
26C O N T I N U E DA micturating cystourethrogram (MCUG) may also beneeded to check for reflux in the transplanted or nativekidneys. An MCUG is carried out by filling the bladderwith contrast dye and then using X-rays to visualisebladder emptying and any signs of reflux before andafter the patient passes urine.How should UTIs be treated?According to Rhana, an isolated UTI can generallybe resolved by consulting your GP, but she advisespatients to make sure that an MSU is sent for culturebefore starting an antibiotic. It is also advisable tocheck with your transplant team that the antibioticand dose are appropriate.She says: “If you are getting more than two UTIs in sixmonths or more than three in a year, we would classifythat as recurrent UTI. This should be reported to yourkidney doctor, who may refer you to someone whospecialises in UTIs in transplant patients. There is nobenefit in using repeated courses of antibiotics if theactual source of the UTI has not been identified usingprecise diagnostics.“I cannot emphasise enough the importance ofspending time to identify each patient’s individualrisk factors and devising a management plan thataddresses all of these accordingly. When I have thisdiscussion with my patients, they understand theunderlying problems and feel less frustrated with theirsituation,” she adds.How can UTIs be prevented?Rhana advises that preventing UTIs involves acombination of approaches that starts with simplemeasures. These include regular drinks of water,emptying the bladder every three hours during theday with a double void (Table 2) to ensure completeemptying, ensuring good gut health, and wiping fromfront to back after emptying the bowels.Table 2. How to empty the bladder with doublevoidingWomenSit comfortably on the toilet leaning slightly forwardRest your hands on your knees or thighs to optimisethe position of the bladder for emptyingPee as normal, focusing on emptying the bladder asmuch as possibleStay sitting on the toilet for 20-30 seconds or standup and walk around for 10 secondsIf needed, sit back on the toilet, then lean slightlyfurther forward and pee againAvoid straining when you are peeing as this canaffect pelvic floor musclesMenAim to relax before you start to peeAfter you think you have finished peeing, relax for afurther 30-60 secondsThen try to pee again to fully empty the bladderPenetrative sexual intercourse may increase the riskof recurrent UTIs in women. Measures such emptyingyour bladder afterwards, wiping from front to back anddouble voiding may be sufficient, though some womenmay need to take one post-intercourse preventiveantibiotic tablet. For postmenopausal women, topicaloestrogen with/without a vaginal moisturiser such asSylk or Replens help treat vaginal atrophy and reducethe likelihood of UTIs. Women of all ages should avoidusing soaps and ‘feminine’ products that irritate thegenital area.Cranberry juice is often recommended for UTIprevention, but Rhana advises using a tablet“It’s alsoimportantfor UTIpreventionto maintain ahealthy gut”
27formulation. This is likely to be more effectivein combination with another product such asD-mannose and the other simple preventivemeasures described above.“Drink cranberry juice if you enjoy it but choosetablets for UTI prevention. There is far more cranberryextract in one tablet than in many glasses of juice. Youcan take cranberry in combination with D-mannose,a simple sugar that is related to glucose and has beenshown to reduce the risk of uncomplicated UTIs inwomen without transplants. As with any over-thecountermedicine, always check with your kidneydoctor that you can take cranberry tablets andD-mannose, especially if you have other conditionssuch as diabetes,” she advises.It’s also important for UTI prevention to maintain ahealthy gut that promotes a regular bowel habit. Inimmunosuppressed patients, Rhana recommendscaution against using probiotics or other products withlive culture supplements that claim to support thegut microbiome (the micro-organisms that live in thedigestive system).According to Rhana: “There are other ways ofsupporting gut health than using probiotics. Makesure you have a high-fibre, varied diet with lots offruit and vegetables. And talk to your kidney doctorabout adjusting your immunosuppression if you havefrequent diarrhoea or constipation. A healthy gutmicrobiome is very important in transplant patients,and this is why we should be trying to stop antibioticsas soon as possible. While we are treating the UTI withantibiotics they are impairing the gut microbiome andwe risk a vicious circle of UTIs and antibiotics.”She adds: “While I am keen to avoid using antibioticsas far as possible because of their side effects andthe risk of fuelling antibiotic resistance, some patientsmay need prophylactic treatment long-term. However,I always tell patients that, once we have identified thecause of the UTIs, there are many measures we can trybefore having to use long-term antibiotics.”ConclusionsUTIs can be challenging for doctors and frustratingfor patients. Recurrent UTIs can, however, often beresolved by thorough assessment and investigation toidentify each patient’s individual risk factors.“As doctors, we need to treat the patient as a wholeand not just their UTI. This is why I feel strongly aboutthe benefits of a dedicated, specialist UTI clinic fortransplant patients. It is not available to everyone, butI feel that we should work to promote individualisedassessment and avoid blanket prescribing ofantibiotics for UTIs. Because of the success of ourdedicated transplant UTI clinic, we have also set upone of the few specialist UTI clinics for people withouttransplants. Both clinics will enable us to conductresearch and move forward with new treatments,“concludes Rhana.Article by Sue LyonFreelance Medical Writer &Editor, LondonTo find out more about UTIs afterkidney transplantation, visitwww.kidneycareuk.org/learn-moreLEARN MORE“There is nobenefit in givingantibioticsif the actualsource ofthe UTI hasnot beenidentified“
- Page 1 and 2: Spring 2022Issue 16Improvingorgan d
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- Page 5 and 6: LEARN MORE5“National audits show
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26
C O N T I N U E D
A micturating cystourethrogram (MCUG) may also be
needed to check for reflux in the transplanted or native
kidneys. An MCUG is carried out by filling the bladder
with contrast dye and then using X-rays to visualise
bladder emptying and any signs of reflux before and
after the patient passes urine.
How should UTIs be treated?
According to Rhana, an isolated UTI can generally
be resolved by consulting your GP, but she advises
patients to make sure that an MSU is sent for culture
before starting an antibiotic. It is also advisable to
check with your transplant team that the antibiotic
and dose are appropriate.
She says: “If you are getting more than two UTIs in six
months or more than three in a year, we would classify
that as recurrent UTI. This should be reported to your
kidney doctor, who may refer you to someone who
specialises in UTIs in transplant patients. There is no
benefit in using repeated courses of antibiotics if the
actual source of the UTI has not been identified using
precise diagnostics.
“I cannot emphasise enough the importance of
spending time to identify each patient’s individual
risk factors and devising a management plan that
addresses all of these accordingly. When I have this
discussion with my patients, they understand the
underlying problems and feel less frustrated with their
situation,” she adds.
How can UTIs be prevented?
Rhana advises that preventing UTIs involves a
combination of approaches that starts with simple
measures. These include regular drinks of water,
emptying the bladder every three hours during the
day with a double void (Table 2) to ensure complete
emptying, ensuring good gut health, and wiping from
front to back after emptying the bowels.
Table 2. How to empty the bladder with double
voiding
Women
Sit comfortably on the toilet leaning slightly forward
Rest your hands on your knees or thighs to optimise
the position of the bladder for emptying
Pee as normal, focusing on emptying the bladder as
much as possible
Stay sitting on the toilet for 20-30 seconds or stand
up and walk around for 10 seconds
If needed, sit back on the toilet, then lean slightly
further forward and pee again
Avoid straining when you are peeing as this can
affect pelvic floor muscles
Men
Aim to relax before you start to pee
After you think you have finished peeing, relax for a
further 30-60 seconds
Then try to pee again to fully empty the bladder
Penetrative sexual intercourse may increase the risk
of recurrent UTIs in women. Measures such emptying
your bladder afterwards, wiping from front to back and
double voiding may be sufficient, though some women
may need to take one post-intercourse preventive
antibiotic tablet. For postmenopausal women, topical
oestrogen with/without a vaginal moisturiser such as
Sylk or Replens help treat vaginal atrophy and reduce
the likelihood of UTIs. Women of all ages should avoid
using soaps and ‘feminine’ products that irritate the
genital area.
Cranberry juice is often recommended for UTI
prevention, but Rhana advises using a tablet
“It’s also
important
for UTI
prevention
to maintain a
healthy gut”
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